Healthcare Provider Details

I. General information

NPI: 1629174404
Provider Name (Legal Business Name): RAYMOND SHAPIRO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 N QUEEN ST SUITE 103
MARTINSBURG WV
25401-3312
US

IV. Provider business mailing address

PO BOX 4025
GAITHERSBURG MD
20885-4025
US

V. Phone/Fax

Practice location:
  • Phone: 301-639-8393
  • Fax:
Mailing address:
  • Phone: 301-639-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number18045
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD042741L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18045
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD042741L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number18045
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD042741L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: